| NPI | 1962485672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 1426) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 2783) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2007-07-08 |